Download TABLE 1 APPROPRIATE AND REALISTIC TARGETS TO REDUCE COST GROWTH

TABLE 1
APPROPRIATE AND REALISTIC TARGETS TO REDUCE COST GROWTH
“In 2009, health care will account for almost 17% of the nation’s economy (gross domestic product
[GDP]). It is currently projected to increase to 21% of GDP by 2020.
In developing policies to reduce cost growth, what do you think is an appropriate and realistic target to
try to achieve by 2020?”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 211 Respondents
Lower than 16% of GDP
16% of GDP (percentage in 2005)
17% of GDP (current percentage)
19% of GDP (halfway between current and
projected percentage)
21% of GDP (projected percentage for 2020)
Higher than 21% of GDP
Total
(n=211)
Academic/
Research
Inst.
(n=95)
Health
Care
Delivery
(n=48)
Business/
Insurance/
Other
Health
Care
Industry
(n=57)
%
19
14
22
%
19
8
22
%
13
13
31
%
16
12
19
%
27
23
8
41
4
-
44
6
-
40
4
-
49
4
-
38
4
-
-1-
Government/
Labor/
Consumer
Advocacy
(n=26)
TABLE 2
PERCEPTION OF SGR MECHANISM
“The Sustainable Growth Rate (SGR) mechanism is a formula that was enacted by Congress to control
Medicare physician spending growth by reducing fees when spending exceeds a target amount. In recent
years, it has produced a series of scheduled across-the-board physician fee reductions that have been
superseded by legislation. Policymakers have proposed modifying or eliminating the SGR mechanism,
but that would result in higher Medicare spending and an increased federal budget deficit.
Please indicate which of the following statements about the SGR best describes your view.”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 213 Respondents
The SGR should be enforced as written, to
slow the growth of Medicare spending.
The SGR should be repealed, to avoid sharp
reductions in physician fees that might hinder
Medicare beneficiaries’ access to services.
The SGR should be replaced with separate
spending targets for different physician
services, to cut fees for services that have
contributed most to cost growth while
avoiding cuts in fees for other services.
The SGR should be replaced with separate
category-specific spending targets for both
physician and other types of Medicare
services.
The SGR should be replaced with
fundamental provider payment reform.
Unable to judge.
Total
(n=213)
Academic/
Research
Inst.
(n=96)
Health
Care
Delivery
(n=48)
Business/
Insurance/
Other
Health
Care
Industry
(n=58)
Government/
Labor/
Consumer
Advocacy
(n=26)
%
%
%
%
%
3
4
-
3
8
4
7
2
-
-
14
17
17
10
19
9
9
2
12
8
66
60
71
72
58
4
2
8
2
8
2
TABLE 3
PERCEIVED EFFECTIVENESS OF POLICY STRATEGIES FOR CONTROLLING HEALTH CARE COSTS
“How effective do you think each of the following broad policy strategies would be in controlling costs while maintaining or improving
quality?”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 213 Respondents
Reporting information on
provider quality and
efficiency.
Pay-for-performance,
with rewards for highquality and efficient
providers.
Malpractice liability
reform.
Provider payment
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Total
Academic/
Research
Inst..
Health Care
Delivery
%
213
%
96
%
48
Business/
Insurance/
Other
Health Care
Industry
%
58
30%
10%
20%
52%
17%
0
26%
5%
21%
55%
19%
-
31%
6%
25%
54%
13%
2%
36%
19%
17%
43%
21%
-
23%
8%
15%
54%
19%
4%
211
95
48
57
26
45%
9%
35%
44%
10%
1%
31%
5%
25%
55%
14%
1%
46%
13%
33%
40%
13%
2%
61%
16%
46%
26%
12%
-
42%
4%
38%
42%
12%
4%
212
96
48
57
26
24%
8%
16%
42%
32%
2%
16%
5%
10%
43%
42%
-
42%
17%
25%
38%
15%
6%
23%
9%
14%
46%
32%
-
12%
8%
4%
46%
38%
4%
213
96
48
58
26
-3-
Government
/ Labor/
Consumer
Advocacy
%
26
reform, moving away
from fee-for-service
toward more bundled
payment.
All-payer rate setting.
Incentives for patients to
choose high-quality,
efficient providers.
More consumer cost
sharing.
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
70%
32%
38%
22%
3%
5%
72%
28%
44%
21%
3%
4%
69%
35%
33%
19%
4%
8%
64%
41%
22%
33%
3%
77%
31%
46%
19%
4%
210
95
48
56
26
40%
17%
22%
31%
16%
13%
42%
17%
25%
34%
12%
13%
35%
15%
21%
27%
19%
19%
36%
20%
16%
29%
21%
14%
31%
12%
19%
46%
8%
15%
213
96
48
58
26
35%
12%
23%
49%
15%
2%
25%
4%
21%
56%
16%
3%
40%
15%
25%
48%
13%
-
50%
19%
31%
29%
19%
2%
38%
4%
35%
46%
15%
-
211
96
48
56
26
19%
7%
13%
48%
31%
1%
17%
4%
13%
48%
35%
-
17%
8%
8%
52%
27%
4%
29%
9%
20%
45%
27%
-
19%
12%
8%
54%
27%
-
4
TABLE 4
LEVEL OF SUPPORT FOR MEDICARE STRATEGIES TO CONTROL HEALTHCARE
PRICES
“Medicare is the largest payer for health services in the United States. Total Medicare spending depends
on both the prices charged for care and the amount of care provided. Please indicate your level of
support for each of the following strategies focused on the prices Medicare pays for health care.”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 213 Respondents
Academic/
Research
Inst.
Health Care
Delivery
%
213
%
96
%
48
Business/
Insurance/
Other
Health Care
Industry
%
58
82%
81%
88%
76%
88%
56%
26%
8%
6%
4%
56%
25%
9%
3%
6%
67%
21%
4%
4%
4%
45%
31%
10%
12%
2%
62%
27%
4%
8%
-
213
96
48
58
26
Strongly support/
Support (Net)
91%
92%
90%
90%
96%
Strongly support
Support
Oppose
Strongly oppose
Not sure
49%
42%
3%
1%
5%
54%
38%
3%
1%
4%
46%
44%
4%
2%
4%
38%
52%
3%
7%
58%
38%
4%
212
95
48
58
26
Strongly support/
Support (Net)
55%
62%
40%
55%
62%
Strongly support
Support
Oppose
Strongly oppose
Not sure
18%
37%
24%
5%
16%
20%
42%
24%
4%
9%
13%
27%
27%
17%
17%
16%
40%
22%
3%
19%
27%
35%
12%
4%
23%
213
96
48
58
26
72%
65%
77%
76%
77%
23%
48%
16%
26%
39%
22%
23%
54%
8%
21%
55%
16%
23%
54%
12%
2%
1%
6%
2%
4%
10%
13%
8%
7%
8%
Total
n=
Medicare should
negotiate
pharmaceutical
prices.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Payment for durable
medical equipment
should be based on
competitive bidding.
n=
Medicare should
reduce payment
updates for providers
in high-cost
geographic areas.
Differential payment
rates among payers
should be narrowed
over time, bringing
up Medicaid and
Medicare and
lowering commercial
payments.
n=
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
-5-
Government
/ Labor/
Consumer
Advocacy
%
26
TABLE 5
PERCEIVED IMPORTANCE THAT VARIOUS POLICIES BE INCLUDED IN THE FIRST
PHASE OF A PHASED APPROACH TO UNIVERSAL COVERAGE
“The following is a list of specific policies that have recently been proposed as a means of slowing the
rate of health care cost growth in Medicare. Please indicate your level of support for each of the
following strategies.”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 214 Respondents
n=
Increase prescription
drug coverage
premiums for
beneficiaries with
higher incomes.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Bundle payments to
reward hospitals
with low 30-day
readmission rates.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Bring payment of
Medicare managed
care plans in line
with the traditional
fee-for-service
Medicare program.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Decrease payments
to home health
agencies.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Total
Academic/
Research
Inst.
Health Care
Delivery
%
214
%
97
%
48
Business/
Insurance/
Other
Health Care
Industry
%
58
64%
14%
50%
23%
8%
5%
61%
11%
49%
26%
9%
4%
71%
21%
50%
25%
2%
2%
67%
19%
48%
19%
9%
5%
50%
4%
46%
27%
12%
12%
213
96
48
58
26
86%
28%
58%
6%
2%
7%
91%
27%
64%
4%
5%
73%
23%
50%
15%
6%
6%
88%
40%
48%
5%
2%
5%
85%
31%
54%
8%
8%
212
96
48
57
26
77%
43%
34%
10%
2%
10%
81%
52%
29%
7%
1%
10%
77%
46%
31%
10%
13%
68%
28%
40%
16%
4%
12%
73%
50%
23%
8%
8%
12%
212
96
47
58
26
21%
2%
18%
43%
8%
28%
24%
2%
22%
46%
7%
23%
11%
11%
43%
17%
30%
26%
2%
24%
38%
9%
28%
27%
8%
19%
27%
46%
213
96
48
58
26
6
Government
/ Labor/
Consumer
Advocacy
%
26
Establish a
streamlined approval
system for generic
drugs and prevent
drug companies
from blocking the
introduction of
generic competitors.
n=
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Utilize radiology
benefit managers to
avoid unnecessary
CAT and MRI scans.
Increase funding to
the Recovery Audit
Contractor (RAC)
program to eliminate
fraud and abuse and
ensure program
integrity.
Expand the Hospital
Quality
Improvement
Program, linking
payment to
performance on
specific quality
measures.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
n=
Reform the
physician payment
system to improve
quality and
efficiency.
Strongly support/
Support (Net)
Strongly support
Support
Oppose
Strongly oppose
Not sure
213
96
48
58
26
94%
59%
35%
2%
0
3%
98%
63%
35%
2%
92%
54%
38%
4%
4%
93%
62%
31%
2%
2%
3%
96%
69%
27%
4%
211
94
48
57
26
63%
18%
45%
18%
3%
16%
62%
17%
45%
16%
3%
19%
52%
13%
40%
29%
6%
13%
67%
21%
46%
14%
4%
16%
81%
15%
65%
8%
4%
8%
212
96
48
57
26
65%
16%
49%
14%
7%
14%
69%
19%
50%
11%
1%
19%
48%
6%
42%
21%
21%
10%
72%
14%
58%
11%
4%
14%
73%
15%
58%
12%
4%
12%
211
94
48
58
26
87%
31%
55%
6%
1%
6%
84%
24%
60%
6%
10%
90%
25%
65%
2%
2%
6%
84%
41%
43%
10%
3%
2%
85%
31%
54%
4%
8%
4%
213
96
48
58
26
97%
57%
40%
1%
1%
1%
99%
52%
47%
1%
94%
56%
38%
2%
2%
2%
93%
62%
31%
2%
3%
2%
96%
62%
35%
4%
-
7
TABLE 6
EFFECTIVENESS OF DIFFERENT APPROACHES TO OPTIMIZING UTILIZATION OF
HEALTH CARE SERVICES
“How effective do you think each of the following approaches would be in reducing avoidable,
duplicative, or unnecessary utilization of health care services?”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 212 Respondents
Enhance the role of
primary care through
implementation of the
‘medical home’ model.
Improve disease
management for patients
with high-cost or chronic
conditions.
Develop evidence-based
medicine guidelines or
protocols to help
providers determine
when and for whom a
given test or procedure
should be done.
Expand the availability
and interoperability of
health information
technology, including
electronic medical
records and decision
support.
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
Total
Academic/
Research
Inst.
Health Care
Delivery
%
212
%
96
%
48
Business/
Insurance/
Other
Health Care
Industry
%
58
50%
17%
33%
38%
5%
7%
46%
15%
31%
39%
6%
9%
65%
31%
33%
31%
2%
2%
53%
14%
40%
38%
7%
2%
40%
20%
20%
40%
4%
16%
214
97
48
58
26
58%
24%
34%
36%
5%
0
56%
19%
37%
39%
4%
1%
67%
33%
33%
27%
6%
-
55%
22%
33%
34%
10%
-
54%
23%
31%
38%
8%
-
214
97
48
58
26
57%
23%
34%
37%
6%
0
51%
15%
35%
40%
9%
-
67%
27%
40%
31%
2%
55%
24%
31%
40%
5%
-
50%
31%
19%
50%
-
214
97
48
58
26
58%
20%
39%
37%
4%
1%
53%
14%
38%
41%
5%
1%
63%
29%
33%
33%
2%
2%
59%
19%
40%
36%
3%
2%
62%
15%
46%
35%
4%
-
-8-
Government
/ Labor/
Consumer
Advocacy
%
25
Reward more efficient
providers/penalize less
efficient providers.
Require patients to pay a
substantially higher share
of their health care costs.
Require prior
authorization for
expensive or highvolume health care
services.
Require that patients be
provided with objective
information on risks and
benefits of alternative
treatment approaches
before undergoing
invasive procedures.
Provide improved
transitional care for
patients who are being
discharged from the
hospital or other
institutional setting.
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
213
97
47
58
26
55%
22%
34%
37%
6%
2%
49%
19%
31%
44%
3%
3%
60%
21%
38%
28%
13%
-
60%
28%
33%
33%
7%
-
58%
12%
46%
27%
12%
4%
213
97
48
57
26
18%
3%
15%
36%
43%
2%
18%
2%
15%
32%
49%
1%
23%
2%
21%
31%
40%
6%
19%
5%
14%
46%
30%
5%
23%
8%
15%
38%
38%
-
214
97
48
58
26
23%
5%
18%
56%
18%
3%
20%
4%
15%
61%
16%
3%
21%
6%
15%
50%
27%
2%
28%
9%
19%
52%
19%
2%
27%
4%
23%
58%
12%
4%
212
96
48
57
26
44%
14%
30%
45%
10%
1%
42%
9%
32%
43%
15%
1%
50%
21%
29%
40%
8%
2%
44%
18%
26%
46%
11%
-
50%
19%
31%
42%
8%
-
214
97
48
58
26
62%
19%
43%
34%
1%
3%
58%
16%
41%
35%
2%
5%
69%
29%
40%
29%
2%
64%
22%
41%
34%
2%
73%
19%
54%
27%
-
9
TABLE 7
EFFECTIVENESS OF DIFFERENT PROPOSALS TO REDUCING GROWTH OF HEALTH
CARE COSTS
“How effective do you think each of these proposals for structural change in health services markets
would be in reducing the growth of health care costs?”
Note: Percentages may not add up to 100 percent due to rounding or no response
Base: 214 Respondents
Increase the supply of
primary care providers
and public health
practitioners through
loan repayment
programs, training
grants, and infrastructure
support.
Increase the supply of
primary care providers
by raising payments for
primary care services,
providing additional
payments for providers
who serve as a patientcentered medical home
accountable for quality
and efficiency, rewarding
providers for highquality and coordinated
care, and offer incentives
that encourage patients to
enroll in medical homes.
Establish a public/private
center for comparative
effectiveness to produce
and disseminate
information on
effectiveness, guide
clinical practice, and
inform benefit design.
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
Total
Academic/
Research
Inst.
Health Care
Delivery
%
213
%
97
%
48
Business/
Insurance/
Other
Health Care
Industry
%
57
49%
23%
27%
38%
10%
3%
42%
18%
25%
40%
14%
3%
60%
35%
25%
35%
2%
2%
53%
23%
30%
33%
11%
4%
58%
23%
35%
35%
4%
4%
214
97
48
58
26
61%
55%
65%
67%
69%
29%
25%
48%
29%
27%
32%
30%
17%
38%
42%
27%
28%
31%
21%
27%
10%
13%
4%
10%
4%
Government
/ Labor/
Consumer
Advocacy
%
26
2%
4%
-
2%
-
214
97
48
58
26
54%
22%
32%
39%
5%
1%
52%
15%
36%
39%
6%
3%
58%
31%
27%
40%
2%
-
52%
22%
29%
41%
7%
-
62%
35%
27%
35%
4%
-
10
Provide funding to
accelerate the adoption
of health information
technology, promote
uniform standards for
interoperability, and
establish health
information exchange
networks.
Reform the malpractice
liability system.
Promote the growth of
integrated delivery
systems.
n=
Extremely effective/
Very effective (Net)
Extremely effective
214
97
48
58
26
50%
44%
60%
47%
58%
Very effective
19%
31%
19%
26%
31%
29%
16%
31%
4%
54%
Somewhat effective
43%
47%
35%
45%
38%
Not effective
Not sure
7%
0
8%
-
2%
2%
9%
-
4%
-
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
n=
Extremely effective/
Very effective (Net)
Extremely effective
Very effective
Somewhat effective
Not effective
Not sure
212
96
47
58
26
31%
12%
19%
44%
23%
2%
20%
7%
13%
47%
32%
1%
51%
23%
28%
38%
6%
4%
33%
5%
28%
50%
16%
2%
19%
8%
12%
50%
31%
-
213
96
48
58
26
62%
25%
37%
27%
6%
5%
64%
27%
36%
26%
7%
3%
60%
31%
29%
31%
4%
4%
53%
14%
40%
28%
10%
9%
73%
31%
42%
23%
4%
-
11
TABLE 8
TYPE OF EMPLOYMENT
"How would you describe your current employment position?"
Base: 211 Respondents
%
24
30
5
2
2
24
18
1
14
18
3
8
8
6
4
4
Policy analyst
Researcher/Professor/Teacher
Dean or department head
Policymaker or policy staff (federal)
Policymaker or policy staff (state)
CEO/President
Management/Administration
Lobbyist
Consultant
Physician
Other health care provider (not physician)
Consumer advocate
Health care purchaser
Foundation officer
Retired
Other
12
TABLE 9
PLACE OF EMPLOYMENT
"Which of the following best describes the place or institution for which you work or if retired last
worked?"
Base: 212 Respondents
%
Academic and Research Institutions
Medical, public health, nursing, or other health professional school
University setting not in a medical, public health, nursing, or other health professional
school
Think tank/Health care institute/Policy research institution
Foundation
Government
Non-elected state executive-branch official
Professional, Trade, Consumer Organizations
Medical society or professional association or organization
Allied health society or professional association or organization
Hospital or related professional association or organization
Health insurance and business association or organization
Labor/Consumer/Seniors’ advocacy group
Health Care Delivery
Hospital
Nursing home/Long-term care facility
Clinic
Physician practice/Other clinical practice (patient care)
Health insurance/Managed care industry
Pharmaceutical Industry
Drug manufacturer
Other Industry/Business Settings
CEO, CFO, Benefits Manager
Health care consulting firm
Health care improvement organization
Accrediting body and organization (non-governmental)
Other
13
45
19
8
15
7
1
1
22
6
2
6
4
5
16
6
1
2
5
5
2
2
27
5
10
8
2
7